Human Milk Banking: Successes and Challenges

Successes: Policy

• Government backing• National and regional policies and guidelines developed• Funding support

• Facility backing and engagement• Interdisciplinary teams for optimizing human milk nutrition

• Advocacy and awareness raising • HMB and breastfeeding promotion• Mass media/peer-review journals

• Recognition of successfully implemented system• Integration of messaging

• Neonatal care guidelines include DBM• Impact on breastfeeding practices• Health system cost-savings• Adoption of system to other NICUs

Successes: Operational• Impact on breastfeeding

• Provision of DHM results in increased initiation of breastfeeding in the NICU units

• NICUs with highest BF rates have attached HMB• BF rates higher than formula in discharged NICU infants• Increased BF duration among donors

• Long-term continuous operations• Improved health outcomes

• DHM and supplementation of MOM • Leveraging support from volunteer blood/tissue transport

services (bikes, motorcycles)• Integrated/holistic approach through HMB providing lactation

support and assistance

Successes: Technological

• Improved screening, processing, tracking• Refined and/or simplified systems/equipment/supplies• Ability to assess macronutrient and protein content

• Validated systems• Online accessibility

• Screening, marketing, ordering, prescriptions• Standardized quality assurance and outcome reporting

Challenges: Policy

• Achieving policy level support• HMB and supporting breastfeeding, ie MOM,

lactation support• HMB integrated into other health programs

• Implementing legislation to regulate and standardize HMB

• Uncertainty of DHM importance among health care staff• Establishing sufficient donor base• Balancing promotion of DHM and capacity to meet need

• Supply and demand

Challenges: Policy

• Limited/no financial support from government• Limited/no leadership or interest from government• Economic crisis• Becoming established as regional centre of reference• Expansion to other areas limited by cultural/tribal

concerns• Lack of insurance coverage• For profit and casual sharing impacting donor base

Challenges: Operational

• Identifying and retaining qualified staffing• Depending volunteers not sustainable• Lack of funds for salaries• Refresher trainings needed

• Inadequate training• Need to develop HMB specific training program

• Insufficient donor milk due to insufficient donors• Lack of breastfeeding promotion and support

• For profit and informal milk sharing impact donor base• Lack of eligible donors due to high HIV prevalence• Maintaining consistent demand for DHM from hospitals

to enable growth

Challenges: Operational

• Implementing transport for milk collection• Implementing a communication plan• Need low cost distribution methods• Need protected and effective on-line screening process• Centralized care model changing to accommodate other

level III NICUs• Increased demand could be seen as opportunity for

strengthening preterm lactation success• Limited space• Implementing HACCP

Challenges: Technological

• Achieving optimal pasteurization throughput balanced against wastage• Matching batch volumes with distribution volumes• Need for pasteurizing small volumes

• Time for processing• Defrosting takes a long time

• Introducing electronic testing and reporting systems, bar code tracking systems

• Need for improved pasteurization systems to preserve nutritional and immunological properties – balanced with microbial safety

Challenges: Technological

• Low cost bottling units that do not retard or chip • Low cost standard methods for testing human milk

• medications, contamination and nutritional analysis • Shipping units specifically for human milk • Mechanized processing equipment

• Provides homogenized milk• Pouring accuracy